Even when a BPD diagnosis is suspected, clinicians may actually avoid disclosing it to patients, according to a study published last month by researchers at the University of Wisconsin-Madison, the University of North Carolina at Chapel Hill, and the National Alliance on Mental Illness.3 Based on semi-structured interviews with 32 mental health professionals compared with reports from 32 patients, findings show that most of the clinicians “did not actively share the BPD diagnosis with their patients, even when they felt it was the most appropriate diagnosis,” the authors reported.

“Clinicians believed that by not using the BPD label they were acknowledging or sidestepping the stigma of the condition,” they added. The majority of patients sampled, however, wanted to be informed of the diagnosis and to openly discuss the associated stigma with their providers. Additionally, results consistently show that patients who subsequently learned of the withheld diagnosis left treatment.

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“It is really a shame that many clinicians hold these beliefs about patients with BPD,” said Dr Sulzer. “First of all, there is great heterogeneity in the BPD diagnosis — there are over 300 combinations of the nine diagnostic criteria, and most folks with BPD are not in and out of the hospital.”

Ample evidence indicates that BPD patients can actually show improvement over time whether they receive treatment or not,she says, and for those with more severe symptamology, treatments such as dialectical behavior therapy,4 mentalization-based treatment,5 and general psychiatric management have been found to be effective.

BPD co-occurs with other disorders such as depression and anxiety in up to 75% of cases, noted Dr Sauer-Zavala, and it has been suggested that there may be shared temperamental vulnerabilities between these disorders, including “the trait-like tendency to experience negative emotions and aversive reactions to these emotional experiences when they occur,” she said. “Taken together, these risk factors lead to efforts to avoid or suppress emotions which backfires leading to even more negative emotions via rebound effects.”